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Tremblay M, Girard-Côté L, Brais B, Gagnon C. Documenting manifestations and impacts of autosomal recessive spastic ataxia of Charlevoix-Saguenay to develop patient-reported outcome. Orphanet J Rare Dis 2022; 17:369. [PMID: 36183078 PMCID: PMC9526980 DOI: 10.1186/s13023-022-02497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autosomal recessive cerebellar ataxias (ARCA) are a group of rare inherited disorders characterized by degeneration or abnormal development of the cerebellum. Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is one of the most prevalent in Europe. OBJECTIVES The aim of this study is to provide a better understanding of the manifestations and impacts of ARSACS. METHODS A systematic review of the literature was conducted, followed by a qualitative study using semistructured interviews and discussion groups to obtain the experience of people affected. RESULTS According to the PROMIS framework, the results show manifestations and impacts in three components of health: physical, mental, and social. Fatigue and struggles with balance and dexterity are the physical manifestations of the disease most often cited by participants. Negative affects such as frustration and depression are among the mental health impacts with some loss in cognitive abilities. Social health is the least documented component; nonetheless, people with the disease report significant impacts in terms of social relationships, activities and work. CONCLUSIONS These findings shed new light on the experience of people with recessive ataxia and identify key aspects to assess to improve their overall health.
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Affiliation(s)
- Marjolaine Tremblay
- Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada. .,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, 2230 de l'Hôpital cp 1200, Jonquière, QC, G7X 7X2, Canada.
| | - Laura Girard-Côté
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, 2230 de l'Hôpital cp 1200, Jonquière, QC, G7X 7X2, Canada.,Université du Québec à Chicoutimi, 555, boulevard de l'Université, Chicoutimi, QC, G7H 2B1, Canada
| | - Bernard Brais
- McGill University, 845 Sherbrooke Street West, Montréal, QC, H3A 0G4, Canada.,Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Cynthia Gagnon
- Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, 2230 de l'Hôpital cp 1200, Jonquière, QC, G7X 7X2, Canada.,Centre de recherche du Centre hospitalier universitaire de Sherbrooke, 3001, 12e Avenue Nord, aile 9, porte 6, Sherbrooke, QC, J1H 5N4, Canada
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Çakar A, İnci M, Özdağ Acarlı AN, Çomu S, Candayan A, Battaloğlu E, Tekgül Ş, Başak AN, Durmuş H, Parman Y. Phenotypical spectrum of SACS variants: Neuromuscular perspective of a complex neurodegenerative disorder. Acta Neurol Scand 2022; 145:619-626. [PMID: 35130357 DOI: 10.1111/ane.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/05/2022] [Accepted: 01/24/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is caused by the SACS gene variants. Main clinical features include early-onset and progressive cerebellar ataxia, spasticity, sensorimotor polyneuropathy. However, the phenotypic spectrum expanded with the increased availability of next-generation sequencing methods. MATERIALS AND METHODS Herein, we describe the clinical features of nine patients from seven unrelated families with SACS variants from the cohort of the Neuromuscular Disorders Unit of the Neurology Department of the Istanbul University, Istanbul Faculty of Medicine. RESULTS Seven patients were male. Seven patients in our cohort had disease onset in the first decade of life. Eight patients were born to consanguineous marriages. Distal weakness in the lower limbs was a prominent feature in all of our patients. Seven patients had ataxia, and six patients had spasticity. Interestingly, one patient showed an isolated Charcot-Marie-Tooth-like phenotype. Five patients showed sensorimotor demyelinating polyneuropathy in the nerve conduction studies. Linear pontine hypointensity was the most frequent cranial magnetic resonance imaging (MRI) abnormality. Two patients with a later disease onset had a homozygous c.11542_11544delATT (p.Ile3848del) variant. The rest of the identified variants were scattered throughout the SACS gene. CONCLUSIONS Atypical clinical features in our patients highlight that the phenotypic spectrum of ARSACS can be observed in a wide range.
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Affiliation(s)
- Arman Çakar
- Neuromuscular Unit Department of Neurology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Meltem İnci
- Neuromuscular Unit Department of Neurology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Ayşe Nur Özdağ Acarlı
- Neuromuscular Unit Department of Neurology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Sinan Çomu
- Department of Pediatrics Division of Pediatric Neurology Sisli, Memorial Hospital Istanbul Turkey
| | - Ayşe Candayan
- Department of Molecular Biology and Genetics Bogazici University Istanbul Turkey
| | - Esra Battaloğlu
- Department of Molecular Biology and Genetics Bogazici University Istanbul Turkey
| | - Şeyma Tekgül
- Suna and Inan Kıraç Foundation Neurodegeneration Research Laboratory KUTTAM Koc University School of Medicine Istanbul Turkey
| | - Ayşe Nazlı Başak
- Suna and Inan Kıraç Foundation Neurodegeneration Research Laboratory KUTTAM Koc University School of Medicine Istanbul Turkey
| | - Hacer Durmuş
- Neuromuscular Unit Department of Neurology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Yeşim Parman
- Neuromuscular Unit Department of Neurology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
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Wang Z, Song Y, Wang X, Li X, Xu F, Si L, Dong Y, Yao T, Zhu J, Lai H, Li W, Lin F, Huang H, Wang C. Autosomal recessive spastic ataxia of Charlevoix-Saguenay caused by novel mutations in SACS gene: A report of two Chinese families. Neurosci Lett 2021; 752:135831. [PMID: 33746006 DOI: 10.1016/j.neulet.2021.135831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/27/2022]
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare hereditary disease characterized by cerebellar ataxia, pyramidal signs in lower limbs, and sensorimotor neuropathy. The disease is caused by bi-allelic mutations of the SACS gene encoding the sacsin protein. Over 200 mutations have been reported worldwide. Here, we report two unrelated Chinese ARSACS patients with novel mutations revealed by whole-exome sequencing (WES). One 36-year-old female patient exhibited classical ARSACS characteristics including cerebellar ataxia, pyramidal tract signs in the lower limbs and sensorimotor neuropathy, while the other 9-year-old male showed cerebellar ataxia and peripheral neuropathy. WES identified a compound heterozygous variant in the SACS gene (c.5692 G > T, p.E1898X; c.12673-12677 del TATCA, p.Y4225D fs*6) in the female patient and another compound heterozygous variant (c.1773C > A, p.S578X; c.8088-8089 in. CA, p.M2697Q fs*43) in the male patient. All of these novel mutations were predicted to be loss-of-function which affect the expression of the two important C-terminal domains (DnaJ and HEPN). These findings add new insights into the mutational and clinical spectrum of ARSACS.
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Affiliation(s)
- Zhanjun Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yang Song
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xianling Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xuying Li
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China; Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Fanxi Xu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lianghao Si
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yue Dong
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Tingyan Yao
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Junge Zhu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Hong Lai
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Wei Li
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Feng Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huapin Huang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chaodong Wang
- Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Wagner F, Titelbaum DS, Engisch R, Coskun EK, Waugh JL. Subtle Imaging Findings Aid the Diagnosis of Adolescent Hereditary Spastic Paraplegia and Ataxia. Clin Neuroradiol 2019; 29:215-221. [PMID: 29379980 DOI: 10.1007/s00062-018-0665-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/11/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Hereditary spastic paraplegia (HSP) and hereditary spastic ataxia (HSA) are a heterogeneous group of genetic disorders characterized by progressive lower limb spasticity resulting from pyramidal tract dysfunction. By identifying critical imaging findings within the clinical context of spasticity, radiologists are uniquely positioned to recommend specific genetic testing, and thus facilitate diagnosis. METHODS We present two examples of HSP and HSA that had gone clinically unrecognized for years, and in which magnetic resonance imaging played a critical role in the diagnosis. RESULTS Radiologists' awareness of HSP and HSA, combined with a critical review of the clinical history and characteristic imaging findings led to specific genetic testing and a definitive diagnosis. CONCLUSION Awareness of HSP and HSA among radiologists will expedite more accurate diagnosis, explanation of patient symptoms, recommendation for syndrome-specific treatment, and family planning considerations.
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Affiliation(s)
- Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bern, University of Bern, Bern, Switzerland.
| | | | - Renate Engisch
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Jeff L Waugh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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SACS variants are a relevant cause of autosomal recessive hereditary motor and sensory neuropathy. Hum Genet 2018; 137:911-919. [PMID: 30460542 DOI: 10.1007/s00439-018-1952-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022]
Abstract
Mutations in the SACS gene have been initially reported in a rare autosomal recessive cerebellar ataxia syndrome featuring prominent cerebellar atrophy, spasticity and peripheral neuropathy as well as retinal abnormalities in some cases (autosomal recessive spastic ataxia of Charlevoix-Saguenay, ARSACS). In the past few years, the phenotypic spectrum has broadened, mainly owing to the availability and application of high-throughput genetic testing methods. We identified nine patients (three sib pairs, three singleton cases) with isolated, non-syndromic hereditary motor and sensory neuropathy (HMSN) who carried pathogenic SACS mutations, either in the homozygous or compound heterozygous state. None of the patients displayed spasticity or pyramidal signs. Ataxia, which was noted in only three patients, was consistent with a sensory ataxia. Nerve conduction and nerve biopsy studies showed mixed demyelinating and axonal neuropathy. Brain MRI scans were either normal or revealed isolated upper vermis atrophy of the cerebellum. Our findings confirm the broad clinical spectrum associated with SACS mutations, including pure polyneuropathy without characteristic clinical and brain imaging manifestations of ARSACS.
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van Lint M, Hoornaert K, Ten Tusscher MPM. Retinal nerve fiber layer thickening in ARSACS carriers. J Neurol Sci 2016; 370:119-122. [PMID: 27772739 DOI: 10.1016/j.jns.2016.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Two Caucasian Belgian families were diagnosed with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). The ophthalmological findings in both ARSACS disease and carriers are described. METHODS In addition to a complete ophthalmological assessment, in both patients and carriers, spectral-domain Optical Coherence Tomography scans of the peri-papillary retinal nerve fiber layer were performed. RESULTS Molecular analysis revealed a missense mutation which has not been reported before. Besides patients with ARSACS, who also presented additional ophthalmological abnormalities i.e. eye movement problems, ARSACS carriers demonstrated thickening of the retinal nerve fiber layer. CONCLUSION The most conspicuous ophthalmological feature of ARSACS is an increased thickness of the peri-papillary retinal nerve fiber layer. Retinal striation and thickening of the nerve fiber layer on spectral-domain Optical Coherence Tomography appeared also in carriers of the ARSACS-gene. Other ophthalmological features encountered, were gaze-evoked nystagmus and rebound nystagmus.
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Affiliation(s)
- Michel van Lint
- Department of Ophthalmology, University Hospital Vrije Universiteit Brussel, Brussels, Belgium
| | - Kristien Hoornaert
- Department of Ophthalmology, General Hospital Maria Middelares, Ghent, Belgium
| | - Marcel P M Ten Tusscher
- Department of Ophthalmology, University Hospital Vrije Universiteit Brussel, Brussels, Belgium.
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Romano A, Tessa A, Barca A, Fattori F, de Leva MF, Terracciano A, Storelli C, Santorelli FM, Verri T. Comparative analysis and functional mapping of SACS mutations reveal novel insights into sacsin repeated architecture. Hum Mutat 2013; 34:525-37. [PMID: 23280630 PMCID: PMC3629688 DOI: 10.1002/humu.22269] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 12/06/2012] [Indexed: 01/01/2023]
Abstract
Autosomal recessive spastic ataxia of Charlevoix–Saguenay (ARSACS) is a neurological disease with mutations in SACS, encoding sacsin, a multidomain protein of 4,579 amino acids. The large size of SACS and its translated protein has hindered biochemical analysis of ARSACS, and how mutant sacsins lead to disease remains largely unknown. Three repeated sequences, called sacsin repeating region (SRR) supradomains, have been recognized, which contribute to sacsin chaperone-like activity. We found that the three SRRs are much larger (≥1,100 residues) than previously described, and organized in discrete subrepeats. We named the large repeated regions Sacsin Internal RePeaTs (SIRPT1, SIRPT2, and SIRPT3) and the subrepeats sr1, sr2, sr3, and srX. Comparative analysis of vertebrate sacsins in combination with fine positional mapping of a set of human mutations revealed that sr1, sr2, sr3, and srX are functional. Notably, the position of the pathogenic mutations in sr1, sr2, sr3, and srX appeared to be related to the severity of the clinical phenotype, as assessed by defining a severity scoring system. Our results suggest that the relative position of mutations in subrepeats will variably influence sacsin dysfunction. The characterization of the specific role of each repeated region will help in developing a comprehensive and integrated pathophysiological model of function for sacsin.
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Affiliation(s)
- Alessandro Romano
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
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Prodi E, Grisoli M, Panzeri M, Minati L, Fattori F, Erbetta A, Uziel G, D'Arrigo S, Tessa A, Ciano C, Santorelli FM, Savoiardo M, Mariotti C. Supratentorial and pontine MRI abnormalities characterize recessive spastic ataxia of Charlevoix-Saguenay. A comprehensive study of an Italian series. Eur J Neurol 2012; 20:138-46. [PMID: 22816526 DOI: 10.1111/j.1468-1331.2012.03815.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 06/12/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is an early-onset neurodegenerative disorder caused by mutations in the SACS gene. The disease, first described in Canadian families from Québec, is characterized by cerebellar ataxia, pyramidal tract involvement and peripheral neuropathy. METHODS Analysis of SACS gene allowed the identification of 14 patients with ARSACS from 13 unrelated Italian families. Clinical phenotype, gene mutations and magnetic resonance imaging (MRI) findings were analysed. RESULTS We found 16 novel SACS gene mutations, including a large in-frame deletion. The age at onset was in infancy, but one patient presented the first symptoms at age 32. Progression of the disease was variable, and increased muscle tone was mostly recognized in later stages. Structural MRI showed atrophy of the superior cerebellar vermis, a bulky pons exhibiting T2-hypointense stripes, identified as the corticospinal tract (CST), thinning of the corpus callosum and a rim of T2-hyperintensity around the thalami in 100% of cases. The presence of iron or other paramagnetic substances was excluded. Diffusion tensor imaging (DTI) revealed grossly over-represented transverse pontine fibres (TPF), which prevented reconstruction of the CST at this level (100% of cases). In all patients, significant microstructural alterations were found in the supratentorial white matter of forceps, cingulum and superior longitudinal fasciculus. CONCLUSIONS Our findings further enlarge the genetic spectrum of SACS mutations and widen the study of clinical phenotype. MRI characteristics indicate that pontine changes and supratentorial abnormalities are diagnostic. The over-representation of TPF on DTI suggests a developmental component in the pathogenesis of the disease.
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Affiliation(s)
- E Prodi
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Shimazaki H, Takiyama Y, Honda J, Sakoe K, Namekawa M, Tsugawa J, Tsuboi Y, Suzuki C, Baba M, Nakano I. Middle Cerebellar Peduncles and Pontine T2 Hypointensities in ARSACS. J Neuroimaging 2012; 23:82-5. [DOI: 10.1111/j.1552-6569.2011.00647.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Narayanan V, Rice SG, Olfers SS, Sivakumar K. Autosomal recessive spastic ataxia of Charlevoix-Saguenay: compound heterozygotes for nonsense mutations of the SACS gene. J Child Neurol 2011; 26:1585-9. [PMID: 21745802 DOI: 10.1177/0883073811412825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mutations of the SACS gene have been reported in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay from Canada (Quebec), Tunisia, Japan, Turkey, Belgium, Italy, Spain, the Netherlands, and Germany. Features that distinguish autosomal recessive spastic ataxia of Charlevoix-Saguenay from other recessive ataxias include sensory motor polyneuropathy and hypermyelinated retinal nerve fibers. We describe the clinical, electrophysiological, and radiological features in 2 white American siblings diagnosed with autosomal recessive spastic ataxia of Charlevoix-Saguenay. The 2 affected children are compound heterozygotes for nonsense mutations of the SACS gene (c. 3484 G>T, p. E 1162 X; and c. 11,707 C>T, p. R 3903 X). We have measured allele-specific SACS mRNA abundance in peripheral blood and show that these specific mutant mRNAs are not degraded. We suggest that in children with early onset cerebellar ataxia and spasticity, ophthalmological examination and nerve conduction testing may guide genetic testing.
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Affiliation(s)
- Vinodh Narayanan
- St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
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Pedroso JL, Braga-Neto P, Abrahão A, Rivero RLM, Abdalla C, Abdala N, Barsottini OGP. Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS): typical clinical and neuroimaging features in a Brazilian family. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:288-91. [PMID: 21625752 DOI: 10.1590/s0004-282x2011000300004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/18/2010] [Indexed: 12/31/2022]
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neurodegenerative disorder characterized by late-infantile onset spastic ataxia and other neurological features. ARSACS has a high prevalence in northeastern Quebec, Canada. Several ARSACS cases have been reported outside Canada in recent decades. This is the first report of typical clinical and neuroimaging features in a Brazilian family with probable diagnosis of ARSACS.
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Affiliation(s)
- José Luiz Pedroso
- Department of Neurology and Neurosurgery, Division of General Neurology and Ataxias, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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